Incidence of malaria and efficacy of oral quinine in patients recently infected with human immunodeficiency virus in Kinshasa, Zaire

Summary There is concern that the impaired cell mediated immunity caused by the human immunodeficiency virus may increase the risk or severity of Plasmodium falciparum infection and could lead eventually to a decreased response to standard antimalarial treatment. In 1986, at Mama Yemo Hospital, Kinshasa, Zaire, the incidence of malaria was determined in a cohort of 59 patients who had recently acquired HIV-1 infection through blood transfusion and in a cohort of 83 HIV-1 seronegative controls who were recipients of HIV-1 seronegative blood. All cohort patients were asked to visit the study physician whenever they developed fever. On each of these occasions thick film was examined for the presence of malarial parasites. HIV-1 seropositive patients presented more often with episodes of fever per person month observation than HIV-1 seronegative patients ( P = 0·003). The total number of positive thick films per person months observation was significantly higher among HIV-1 seropositive patients than among the HIV-1 seronegative ones, but percentages of positive thick films per episode of fever were the same in both groups (46 %). During a 5 month period, cohort patients presenting with a moderate attack of malaria were treated with oral quinine 20 mg/kg daily in two doses for 5 days. Twenty-three (92 %) of 25 HIV-1 seropositive patients and 28 (82%) of 34 HIV-1 seronegative patients had a negative film 7 days after starting treatment. This study suggests that there seems to be no direct interaction of major clinical importance between HIV infection and malaria.